Saturday 23rd March 2013
For any other enquires please email David at
djwconiston14@live.co.uk
Please Fill all boxes
Title:
Birth Date:
First Name:
Age on Race Day:
Surname:
Member of AthleticGroup:
Male/Female:
Male
| Female
Name of Club:
Telephone:
Email:
Address 1:
Signed:
Address 2:
Date:
Town/City:
Postcode:
Please tick the box with the correct fee
UK Athletes
Unattached: (includes increased levy of £2 to UKA)
Living in Coniston/Torver
UKA
£20.00
U/A
£22.00
Local
£20.00
Declaration For all Runners:
I declare that I will abide by the laws and rules of UK athletics i am not under 16 years of age on april 1st 2006 and I agree that the organizers of the Coniston 14 run will not be liable for any loss / damage action claim costs or expenses which may arise in conseqeunce of my participation in this event. I declare that i will not compete in the coniston 14 Run unless i am in good health on April 1st 2006 and that in any event i will compete at my own risk. I agree to have my personal details stored on computer for processing.
